Medicare Status Quo Argument Ailing

Not so very long ago, there was a triumphalist air among the apologists for the status quo. The Romanow commission, headed by a former NDP premier of Saskatchewan, had given a complacent defence of the current system. The one-sentence summary of Roy Romanow was, “There’s nothing wrong with medicare that more money won’t fix.”

A politically popular conclusion, but one not at all justified by the evidence.

On the contrary, our own experience in Canada has repeatedly shown that the health care system is a bottomless money pit, one that will absorb all the cash you can throw at it, but give back little in the way of improved productivity.

That’s why despite several injections of cash over recent years, waiting times, to the extent that we can measure them, are on the whole getting worse, not better.

And by the way, the experience from the U.K. is that making waiting times the focus of political pressure has resulted in health bureaucrats getting big bonuses for quick fixes that have made the health care system worse, not better.

Be that as it may, following the release of the Romanow report, governments across the country duly lined up to pour cash down health care’s voracious maw.

A decade’s effort by various governments and political parties to overcome the public system’s irrational resistance to more private sector participation (an effort I participated in as a member of Alberta’s Mazankowski Committee) was sidelined by the health care system’s collective sigh of relief that nothing would disturb their dogmatic slumbers.

Then came the Supreme Court’s bombshell: In Quebec, at least, and possibly in the rest of the country, we cannot sacrifice patients on the altar of medicare’s bizarre ideology.

It might just pass muster, said the court, to have a public sector monopoly on health care if people got timely care there.

Past some point, however, health bureaucrats’ affection for queues as a way to limit health spending endangers the lives and physical integrity of patients. In those circumstances, the ban on patients seeking care outside the public system violated people’s rights and had to go.
For the fans of the status quo, this was roughly equivalent to standing up in Montreal’s Bell Centre in Game 7 of the Stanley Cup Final and yelling “Go, Leafs.”

Suddenly it was the defenders of the creaking old public system who had to justify their rights violations.

How they hated it.

Recently Professor Bob Evans, medicare’s chief ideologue, wrote: “A court – jurisdictionally arrogant, substantively ignorant and politically irresponsible – has determined that medicare must be restructured to show due respect for the rights of those with money – and the rights of private corporations to make profits – regardless of the wishes of Canadians or the impact on our most important social institution.”

I guess poor old Bob missed the recent survey that showed that the thing Canadians valued most about Canada was the freedoms we enjoy here – the sort of thing the Supreme Court says it is protecting in this case.

The number of people in the survey citing medicare as what they most valued about Canada was almost negligible.

Then there was a recent editorial in the Journal of the Canadian Medical Association that stated, “We need to remember that there is virtually no disagreement that private health care is more expensive and less efficient than publicly funded care.”

But as Artemis Ward once said, “It’s not the things that people don’t know that get them into trouble, it’s the things they know that aren’t actually so.”

Despite the repeated affirmations of the medicare establishment that there is no serious academic research establishing that private care can help lower prices or improve efficiency, all this proves is their ignorance of the very literature they’re citing.

For instance, a recent survey of the peer-reviewed economics literature for my institute by health care economist Brian Ferguson of Guelph University shows that private hospitals, whether for-profits or not-for-profits, are more efficient than government-run hospitals. And private not-for-profit and for-profit hospitals are about equally efficient.

And by the way, the evidence also shows that not-for-profit hospitals behave in similar ways to for-profit hospitals. Not-for-profit hospitals are just as motivated to maximize economic gains as their profit-making counterparts – it just shows up differently.

How did the establishment get it so wrong?

They preferred to get their health care economics from medical journals that ran politically popular but analytically weak articles by people more interested in justifying their ideology than in genuine disinterested inquiry.

The moral of the story? Just as no one should want to be treated by a doctor who claims to have learned his or her medicine in economics journals, we should avoid getting our health care economics from medical journals.

This originally appeared in the Halifax Chronicle-Herald; Moncton Times & Transcript, October 5, 2005.